Healthcare Provider Details

I. General information

NPI: 1417108135
Provider Name (Legal Business Name): DAVID J. HEGARTY PH.D., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 HIGHWATER AVE
MASSAPEQUA NY
11758-8312
US

IV. Provider business mailing address

33 HIGHWATER AVE
MASSAPEQUA NY
11758-8312
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-9415
  • Fax:
Mailing address:
  • Phone: 516-795-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: